
<form id="client" action="index.php" method="POST" enctype="multipart/form-data">
		<input type="hidden" name="<?php echo $url_module_param; ?>" value="client" />
		
		<table id="tbl_client">
		<tr choice="logo"><td colspan="3"><center><img src="" var="logo" /></center></td></tr>
    <tr>
    <td><font color="red">*</font></td><td>Organization</td><td><input class="required" type="text" id="company" name="company" value="" /></td>
    </tr>		
        <tr choice="name">
    <td><font color="red">*</font></td><td>Contact Person</td><td><input class="required" type="text" id="name" name="name" value="" /></td>
    </tr>
    	
    <tr>
    <td>&nbsp;</td><td>Address1</td><td><input type="text" id="address1" name="address1" value="" /></td>
    </tr>
    <tr>
    <td>&nbsp;</td><td>Address2</td><td><input type="text" id="address2" name="address2" value="" /></td>
    </tr>
		<tr>
    <td><font color="red">*</font></td><td>City</td><td><input class="required" type="text" id="city" name="city" value="" /></td>
    </tr>
    <tr>
    <td><font color="red">*</font></td><td>State</td><td><input class="required" type="text" id="state" name="state"  value="" /></td>
    </tr>
    <tr>
    <td><font color="red">*</font></td><td>Country</td><td><input class="required" type="text" id="country" name="country"  value="" /></td>
    </tr>
    <tr>
    <td><font color="red">*</font></td><td>E Mail</td><td><input class="required" type="text" id="email" name="email"  value="" /></td>
    </tr>
    <tr choice="userid">
        <td><font color="red">*</font></td><td>User Name</td><td><input class="required" type="text" id="userid" name="userid"  value="" /></td>
    </tr>
    <tr choice="password">
    <td><font color="red">*</font></td><td>Password</td><td><input class="required" type="password" id="password" name="password"  value="" /></td>
    </tr>
    		<tr>
    <td>&nbsp;</td><td style="vertical-align:top;">Logo</td><td><input type="file" id="logo" name="upload" /><br />
    </td>
    </tr>    
    </table><input type="submit" value="Submit" />
		</form>